Basic Information
| Provider Information | |||||||||
| NPI: | 1265537559 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | OZMENT | ||||||||
| FirstName: | CHARLOTTE | ||||||||
| MiddleName: | REX | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | P.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12817 GULF FWY | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770344807 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2814814100 | ||||||||
| FaxNumber: | 2814814105 | ||||||||
| Practice Location | |||||||||
| Address1: | 12817 GULF FWY | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770344807 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2814814100 | ||||||||
| FaxNumber: | 2814814105 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/13/2006 | ||||||||
| LastUpdateDate: | 03/02/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 2251P0200X | 151035 | TX | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 8T3146 | 01 | TX | BCBS PROVIDER # | OTHER | 107953504 | 05 | TX | MEDICAID |